Comparative analyses between the early postoperative results after major liver resections of colorectal and noncolorectal cancer liver metastases

Abstract

Background: Liver resections (LR) are an obligatory element in the multimodal treatment scheme of colorectal cancer liver metastases (CRCLM). Nowadays still there are debates about the benefit of any aggressive surgical approach in noncolorectal cancer liver metastases (NCRCLM) because many authors report desperately high rates of early specific post-resection complications (SPRC) followed by unsatisfactory long term results.
Aim: Comparative analyses between the SPRC after major liver resections (MLR), i.e. ≥ 2 segments of CRCLM and NCRCLM for confirming or denying the hypothesis of higher risk in the group of NCRLM.
Material and methods: A total of 331 MLR of benign and malignant tumors were performed between 01.01.2007 - 31.12.2014 in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital Sofia. Radical resections received 143 CRCLM patients and 58 NCRCLM patients, both synchronous and metachronous. The design of the study was `a single center` and `retrospective`. The perioperative data of these 201 patients were analyzed and finally 59 cases of CRCLM (Group 1) and 36 cases of NCRCLM (Group 2) were included in the study. All the metastases were metachronous and no significant differences in demography, comorbidity, liver function, ASA group, neoadjuvant chemotherapy and surgery specificity were detected between the two groups. Cases that were indicated for MLR were those under 65 years of age, with preserved liver function, without serious pulmonary and cardiac concomitant diseases, and estimated as ASA group ≤ III. Data about SPRC were collected and analyzed. Results: The entire early postoperative mortality rate was 3.2% (3 fatal outcomes) - 1/59 (1.7%) in group 1 and 2/36 (5.5%) in group 2. The cause of death was liver failure, sepsis and pulmonary embolism. The rate of SPRC was significantly higher in group 2, affecting 16/36 patients (44.4%) while only 18 out of all the 59 patients (30.5%) in group 1 suffered specific complications. However only 5.1% and 8.3% of the SPRC necessitated reoperations in group 1 and group 2 respectfully. The comparative analysis denied any prognostic value for the early SPRC played by the time of metastases detection, adjuvant chemotherapy, the duration of liver resection procedure and the necessity of blood transfusion. Conclusions: Both mortality and specific morbidity after MLR affected patients with ≥3 comorbid conditions which proved to be the only predictive factor for SPRC. SPRC were more frequent in group 2 (NCRCLM) but the great majority of them were solved by conservative measures, less often by interventional procedure and reoperations were indicated very rarely.